Inspection on 03/07/07 for The Rosemary Care Home

This inspection was carried out on 3rd July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Rosemary Care Home 29/03/10

The Rosemary Care Home 03/02/10

The Rosemary Care Home 08/10/09

The Rosemary Care Home 26/08/09

The Rosemary Care Home 26/06/08

The Rosemary Care Home 29/01/07

The Rosemary Care Home 11/07/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Rosemary Care Home The Rosemary Care Home 13 Newhey Road Milnrow Rochdale Lancashire OL16 3NP Lead Inspector Jenny Andrew Unannounced Inspection 3rd July 2007 8:45am X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Rosemary Care Home Address The Rosemary Care Home 13 Newhey Road Milnrow Rochdale Lancashire OL16 3NP 01706 650429 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Din T Vanat ** Post Vacant *** Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (26), Physical disability over 65 years of age (1) of places The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 27 service users, to include: Up to 26 services users in the category of OP (Older People); Up to 1 service user in the category of PD(E) (Physical Disabilities over 65 years of age) The service should employ a suitably experienced and qualified manager who is registered with the Commission for Social Care Inspection 29th January 2007 2. Date of last inspection Brief Description of the Service: The Rosemary Care Home is a privately owned residential home, which provides care for up to 27 older people and one person with a physical disability. The home is in the centre of Milnrow and is close to local shops and pubs. It provides good access to the motorway network. The home is on three floors and there is a passenger lift to all levels. Twenty-one single and three double bedrooms are provided. Two of the bedrooms have the added provision of an en-suite. Two lounges and a dining area are provided on the ground floor and a lounge on the first floor, which is designated as a smoking lounge. A bathroom is provided on each floor and a level access shower room on the ground floor. Two of the baths are fitted with fixed hoists. Toilets are located near to lounge areas and bedrooms. A well maintained garden is available to the front of the home where there is also parking. The most recent Commission for Social Care Inspection (CSCI) report was available in the reception hall. As at July 2007, weekly fees ranged from £334.98 - £345 per week, the higher rate being charged to residents who paid for themselves. The owner said this arrangement had been in place when he had bought the home. He stated the fees for these people would not be raised further until the fees paid by the Local Authority had reached this figure so that the fees would be the same for everyone. Additional charges were for hairdressing, private chiropody, newspapers, toiletries, holidays, spectacles and hearing aid batteries. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The staff at the home did not know this visit was going to take place. The visit lasted eight hours. The inspector looked around parts of the building, checked the records kept on service users to make sure staff were looking after them properly, as well as looking at how the medication was given out. The files of the two newest members of staff were also checked. In order to obtain as much information as possible about how well the home looked after the service users, the owner, manager, seven residents, the deputy manager, one care assistant and the housekeeper were spoken to. In addition, the visiting district nurse was also interviewed. Before the inspection, comment cards were sent out to residents and relatives/carers asking what they thought about the care at the home. One resident and three relatives filled the cards in and returned them to the CSCI. Information from these has also been used in the report. A new manager had been appointed to the home in November 2006. Her application to become registered with the Commission for Social Care Inspection was to be submitted to the Commission for Social Care Inspection the week of the visit. The owner was planning to offer a small number of day care places each week to people who had previously been on respite stays to the home. What the service does well: Before new service users came to live at the home, the manager made sure they had all the right details about them, so that they were clear that the home was the right place for them to live and that their needs would be met. The residents at the home felt the care they received was good. Comments about the staff included “they’re excellent”, “very nice”, “really good”, “are respectful”, “fantastic” and “wonderful”. Other comments made from returned comment cards included “they treat the residents with a great deal of care and respect”, “staff are very patient and caring” and, “I have every confidence that the staff do their best to give residents the appropriate care”. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 6 The residents’ personal and health care needs were being well met. All the residents looked well cared for and if they were ill, the G.P or district nurse was immediately sent for. This prompt action made the residents feel safe. Residents and relatives made the following comments; “when I’m having problems breathing the staff sometimes sit with me for an hour”, “couldn’t be better looked after”, “the staff always get the GP in if they have any concerns and the staff keep my mother clean and well dressed”, “the staff always follow the instructions from the GP and District Nurse” and, “the GP is contacted quickly when needed and medication given regularly”. The District Nurse also praised the home highly for the way they cared for the residents. The residents’ daily routines were flexible and staff worked around the times they wanted to get up and go to bed. Due to the small number of residents currently living at the home, the staff had got to know them well. The owner, who was a nurse, and his wife, who was the deputy manager, were part of the staff team and worked there on an almost daily basis. They had built up good relationships with the residents and the staff. What has improved since the last inspection? The care plans were detailed and had been regularly updated. This meant the staff were all caring for the residents in the way they wanted and their needs were being well met. Where residents were felt to be at risk, the manager had written easily understandable detailed risk assessments showing how the risk could be managed so that the resident would be kept as safe as possible. More staff had received training in what to do if they thought a resident was not being treated properly and those who had not had either been booked on a course or received in-house training. The home was now getting two written references for new staff, before they started working at the home so they could be confident they were employing the right people for the job. All the equipment in the home had been serviced so that it was a safe place for the residents and staff to work in. Staff had been on more training courses so they would know how to care for the people they looked after. Those who had recently come to work at the home still needed to do some courses but the manager was trying to get courses booked for them. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents were assessed before coming into the home to ensure their needs could be satisfactorily met. EVIDENCE: A Statement of Purpose and a Service User Guide were displayed in the entrance hall and these had been recently reviewed and updated to reflect the new owner and manager. A copy of the Service User Guide had been given to each resident. Discussion took place during the visit in respect of the home offering a small number of day care places for people who had previously been on respite stays. The current residents had been consulted about this and were happy with the plans. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 10 One resident said, “The home needs more people living here so that it doesn’t feel as empty”. Another person said, “We need more people to talk to”. The manager said she would review the statement of purpose and service user guide to reflect these changes and send amended copies to the Commission for Social Care Inspection. Prospective residents may visit the home to look around and talk to the staff and residents living there before deciding whether or not the home is right for them. Assessments for three residents were checked. As the home had only had one new permanent resident admitted since the last inspection, a respite stay resident’s assessment was checked, together with an assessment for a resident who had been in the home for two years. All three files contained Service Delivery Agreements from the Local Authority who were funding these placements. The manager had also introduced a system whereby any new referrals would be visited in their own homes or in hospital, by herself or one of the management team. This had been done for the respite stay resident who had come to stay at the home in May 2007. The assessment document showed that six days before her admission, the manager had visited the person in her home and spoken to both her and her husband. Following the initial assessment, further assessments had been completed over the first few days of her stay as the staff team had got to know the person’s needs better. The client’s husband and social worker had also been involved in this process. The completed file was very comprehensive and covered all her needs. Standard 6 was not assessed as the home did not provide intermediate care. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents’ health, personal and social care needs were being well met by staff who knew their preferred routines and lifestyles. EVIDENCE: Three care plans were checked, including one for a resident who had been on a short stay to the home. It was evident the manager had put a great deal of time and effort into the care plans. They were comprehensive and detailed people’s likes/dislikes and preferences in respect of daily living. Recordings such as “likes to lie in”, “breakfast in bed and assist with getting up at about 10.00am and “milky drink before bed” were seen. The plan for the respite stay person was as detailed as those for the permanent stay residents, recording preferred rising and retiring times and that the person liked a glass of cold milk for supper. The plans were written in consultation with the residents and/or their relatives and were regularly reviewed. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 12 The health and personal care needs of the residents were accurately detailed in the care plans. At the last inspection, shortfalls were identified in respect of risk assessments. The manager had now addressed this and comprehensive assessments were in place for falls, skin care, moving/handling, nutrition and any other risks that were pertinent to the individual. She had introduced a visual traffic light system on the risk assessments that had real impact, as at a glance, the reader could determine how serious the risk was. Feedback from the residents spoken to and the returned relative comment cards indicated full satisfaction with how people were being cared for. Review notes on the file of the respite stay resident, before her discharge, showed that improvements during her stay had been identified in respect of diet, continence and communication abilities. The District Nurse was spoken to during the visit. She commented upon improvements in all areas of care, since the home had changed hands and the new manager had taken over. She particularly identified improvements in how quickly they were contacted when problems were identified, the good care given to people with pressure areas or sores, the cleanliness and lack of odour in the home, the friendly management team and staff and how well the staff followed her instructions and sought advice. She gave an example where a resident had a small pressure sore. The staff had followed her instructions and before the pressure sore cushion that she had ordered had been delivered, the pressure sore had healed. A staff handover was observed during the visit. Full details of health care needs of residents, including instructions from the district nurse, were passed on to the staff coming on duty. A health care visits sheet, held on each person’s care plan file, recorded any visits made by GP’s, district nurses, dieticians, podiatrists and opticians. Action to be taken following the visits was recorded. The manager said the local dentist could be contacted and arrangements made for residents to visit the surgery as and when needed. Residents’ weight was being regularly checked and the community dietician was consulted for those residents identified to be at high risk. The medication administration record for one such resident was checked. Build-up drinks were being given on a daily basis in line with the dietician’s advice. The systems in place for the receipt, storage, recording, handling and administration of medication were satisfactory. The Medication Administration Records (MAR) examined were up-to-date and where residents had not been given medication, the code letter had been inserted. Controlled drug records were accurate and storage arrangements appropriate. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 13 The management team and senior carers were responsible for giving out medication. All but one of the most recently recruited staff had completed their training and this person was in the process of completing the third unit of a distance-learning course, which was assessed by an external person. The manager said she would ensure the worker completed the third unit as quickly as possible. The home was actively promoting residents’ independence by encouraging them to manage their own medication. One resident spoken to said he had lockable space where he kept the medicine. A detailed risk assessment had been written which the resident had signed. All the people spoken to felt they were treated with respect and dignity and that staff ensured their privacy needs were met when they helped them with washing and dressing. Staff spoken with were able to give examples of how they promoted this in their daily routines. These included: closing toilet, bathroom and bedroom doors, encouraging people’s independence when bathing and staying outside the bathroom door, if this was what the person wanted, knocking on doors before entering and keeping people covered up when helping with personal care needs. Many of the staff had been shown a video in respect of privacy and dignity. Sufficient male carers were employed to ensure the needs of the men could be met, if they did not wish female carers to undertake the more intimate tasks. Staff always assisted residents to their bedrooms when health care professionals called to see them and this was observed during the visit. Out of 24 bedrooms, 21 were for single occupancy. Due to the low occupancy in the home, all the residents were in single rooms and enjoyed the privacy this provided. A number chose to spend the day in their rooms but said they enjoyed the time staff spent chatting to them. The staff spoken to also said that when they had any spare time, they would sit with residents either in the lounges or in their rooms and this was seen to happen during the inspection. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents were encouraged and supported to exercise choice in their daily routines in relation to lifestyle and to maintain contact with their relatives but social stimulation was lacking and resulted in residents sometimes feeling bored. EVIDENCE: Due to low occupancy in the home, the staff were finding it difficult to arrange a programme of activities to suit the people currently living there. Several of the residents liked to spend time in their rooms, which meant the number of people in the lounge was further reduced and motivation of the remaining people was low. Staff were, however, spending time on a one to one basis chatting with people. Reminiscence packs were also being used, as well as DVD’s. Two residents enjoyed the local talking newspaper and books. One resident said he liked to read his daily paper and another resident was reading one of the books supplied by the home. Two residents said they did sometimes get bored and wanted something more to keep themselves occupied. They could not however, say what they would like. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 15 Discussion took place with the manager about this shortfall and she said she would speak on an individual basis to the residents to try and put together an activity programme to meet their needs. She had already identified this was an area for improvement on the returned Annual Quality Assurance Assessment form. The owner and manager said that when occupany increased, they would be employing a part-time activitity worker. In the interim, she had recently asked two of the staff team to spend time each day focusing on activities for the residents but there was nothing recorded on the three files inspected, since May 2007. One resident went out independently on a daily basis to the local club and clearly enjoyed these outings. He said he just told the staff he was going and there were no rules or restrictions placed on him and clearly enjoyed the independence this afforded him. Residents’ birthdays were celebrated and special days during the year, such as Christmas, Easter, etc. The manager said she was trying to arrange a garden party to which relatives and friends would be invited as soon as the weather improved. The religious needs of the present resident group were being met. The Roman Catholic priest visited the home regularly, as did the local vicar and a representative from the local Methodist church. Residents spoken with were satisfied with the arrangements in place. All the residents spoken to felt the staff respected their preferred routines and lifestyles and evidence of this was seen during the inspection. They could get up when they wanted, choose to eat in their rooms or at the dining tables and had the choice of three lounges, two on the ground floor and a designated smoking lounge on the first floor. Whilst residents may handle their own finances, at the time of the inspection, the relatives or advocates were tending to have control in this area. One resident managed his own finances. Discussion took place about advocacy arrangements and the manager was knowledgeable about who to approach if this was needed. There were no restrictions made on visiting times for relatives/friends. One comment card said “the home makes visitors feel welcome”. The staff team valued the role which relatives and friends could continue to play in the lives of the residents and their participation was encouraged. An example of this was seen on a resident’s care plan, where it was recorded that the relative liked to take the person they visited to their own home in order to bathe and wash their hair themselves. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 16 Feedback from residents spoken to was fairly positive about the food, with the majority describing it as “fine” or “alright”. However, odd comments were made about how it could be further improved. One person said there were too many soft meals, such as shepherds pie and other similar mince type meals. Another person said many of the meals were repetitive and that some of the ideas put forward at a residents meeting had not yet been implemented. One person said the quality of the meal depended upon which cook was on duty. This was discussed with the manager. New menus were in the process of being written which were incorporating the suggestions made at the meeting. From checking the four-weekly menus, it was identified that several of the same meals appeared on a weekly basis. A choice of two meals were offered at lunch time together with dessert and either soup, sandwiches or a hot snack were available at teatime. The choice of meal on the inspection day was shepherds pie or fish fingers with mixed vegetables followed by rice pudding. The inspector sampled the shepherds pie which was a tasty and filling meal. Following a request made by a resident, the manager had recently introduced a “brunch” type meal on a Saturday which residents enjoyed. Milky drinks were available at supper time along with biscuits, sandwiches or toast. Mealtimes were unhurried and the tables were appropriately set. Several residents chose to eat in their bedrooms and this was not a problem. The special dietary needs of the residents were being met. Jugs of juice or water were provided in lounges and residents’ rooms. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. An effective complaints system was in place which relatives and residents were familiar with and staff training and good recruitment practices ensured that residents were protected from abuse. EVIDENCE: The service user guide, which each service user had a copy of, contained the home’s complaints procedure. Feedback from comment cards and from speaking to the residents, indicated they knew how to make a complaint. They said the owner and manager of the home were always around to speak to and would feel able to report any concerns to them. Two residents said they always raised issues before they became complaints and that the staff always sorted things out for them. Comments made on the relative returned comment cards included, “they respond quickly to problems, know their residents well enough to spot problems and potential problems quickly” and, “keep relatives informed not only about problems but also the person’s general well being”. One person said she would go via the Social Services Department if she had a complaint. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 18 The Commission for Social Care Inspection has not had cause to investigate any complaints in the home since the last key inspection. One investigation had, however, taken place which had been carried out by Rochdale MBC Social Services department about personal care needs not being met. The home had not received any written outcome following the investigation but said the complaint had been upheld. No other complaints had been recorded by the home. Feedback from residents indicated they felt safe living at the home. A procedure for responding to allegations of abuse was available, as was an inter-agency procedure. Since the last key inspection, staff had been issued with their own shortened version copies of Rochdale MBC’s vulnerable adult procedure. The majority of staff, including the owner, deputy and manager had attended Protection of Vulnerable Adult (POVA) training. Two had been booked on a July course and a further two were booked on the course in September 2007. The staff files inspected showed that Criminal Record Bureau and POVA first checks were being done to ensure that the staff were suitable to work with vulnerable people. A video in respect of maintaining people’s dignity had recently been shown and discussed with residents and all the staff team. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The premises were clean and provided a safe, hygienic and homely setting for residents to live. EVIDENCE: The home owner had continued to slowly improve the environment of the home in line with his maintenance programme. Two new hand held showers were due to be fitted in two of the bathrooms the week of the visit. He had however, been somewhat restricted due to the resources available, given the low number of residents currently in situ. However, the manager had successfully applied for a Council capital grant and, as a result, the following areas were to be addressed: re-decoration of the communal lounges and dining room, new lounge and dining room carpets, ten tables, 20 easy chairs and new blinds/curtains in communal areas. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 20 Many of the vacant bedrooms were in need of complete refurbishment but some were ready for new occupants. As and when occupancy increases, further bedrooms were to be upgraded. The bedrooms currently being occupied were seen and were in reasonable decorative order and adequately furnished. The residents were happy with their bedrooms, several preferring to use them throughout the day. One resident said she viewed her room as her own home. Comments were however, made by two residents about the lack of hot water in their wash hand basins in a morning. One person also said there were occasions when staff could only give one resident a bath during the evening due to lack of hot water. The bedrooms where water temperatures were only tepid were, 1, 2, 15, 18, 28 & 32. The hot water in bathroom number 19 was only warm and certainly not hot enough to bathe in. Staff said there were instances when they had to carry jugs of hot water to bedrooms and bathrooms. This is a health and safety hazard and needs to be promptly attended to. This problem was highlighted at the last inspection and following a requirement made, the owner had requisitioned a plumbing company to check the system and re-set the valves. An invoice was seen for the work undertaken. Clearly this had not rectified the problem. The owner was spoken to during the visit and he immediately contacted the plumbing company requesting another visit. The grounds around the home were attractive and well kept, and provided residents with an outside area to enjoy in the better weather. Residents said they could get around the home fairly easily and appropriate aids and adaptations were fitted in bathrooms, toilets and corridors so that residents could remain as independent as possible. Two residents on the second floor level were able to operate the lift independently and enjoyed the freedom this gave them. A visit from the Environmental Health Officer had taken place since the last key inspection. Several recommendations had been made. The follow-up visit confirmed the officer was satisfied with the action taken by the provider. Infection control policies/procedures were in place. At lunch time, staff were seen to change protective aprons to blue ones for serving food. Liquid soap and paper towels were supplied in bedrooms, toilets and bathrooms to try and prevent the spread of infection. Adequate laundry facilities were in place and individual baskets supplied for each resident’s clothes. Feedback from residents indicated that missing clothing was not a big problem and a part-time laundry assistant was employed. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 21 The home was clean throughout and the housekeeper took a real pride in her work. She knew the individual residents and those who used their rooms throughout the day spoke well of her. Due to the size of the home, additional cleaning duties were undertaken by the owner and his wife to ensure the home remained fresh and clean when she was off duty. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home was adequately staffed to ensure the needs of the residents were being met and a thorough recruitment process meant that the staff employed were safe to work with vulnerable people. EVIDENCE: From checking the staff rotas and from speaking to the residents, it was evident there were sufficient staff on duty, both during the day and at night, to meet the needs of the 11 people currently living at the home. The owner was a qualified Registered General Nurse and he worked on the floor on an almost daily basis. A domestic, two cooks and a laundry person were also employed. The multi-cultural staff team was small and there had been little turnover of staff over the last few months. This meant that the residents had got to know the staff well and the staff knew the preferred routines and likes/dislikes of each person. Feedback from the residents was very positive about the management and staff team, including those carers on night duty. Residents indicated the staff were competent, efficient and committed to providing good care to them. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 23 Staff morale was quite low however, due to the fact that the home was receiving very few referrals for permanent residents, by Rochdale MBC Social Services Department. They had however, had several residents staying on a short-term basis. Of the 11 care staff employed, excluding the provider and manager, four had attained their NVQ level 2 qualification and three were due to complete their training shortly. One carer had recently enrolled but had not yet started. At the time of the inspection, this meant the home had attained 37 of trained staff. However, when the other three carers have completed their training, the home will have achieved 64 . Inspection of three staff files showed that the home’s recruitment and selection procedures were being followed. Each file contained application forms, two satisfactory written references and Criminal Record Bureau checks. The manager had introduced Skills for Care training for new employees. From checking the files, it was, however, noted that the training was not being completed within the expected 12 week period. One carer had fully completed the training, one carer, who had started working at the home in March 2007, was only part way through the training and a new night care worker, who had started at the home at the end of May 2007, had his training pack with him so it could not be checked. Discussion took place with the manager about the need for staff to complete their induction training within the given time. Some indication of how the person had been assessed as competent should also be recorded and moving/handling and other mandatory training should be done during this initial 12 week period. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Management of the home had greatly improved which had been reflected in the outcomes for residents with regard to the quality of care they were now receiving. EVIDENCE: A new manager had been recruited and had started work in November 2006. Her application to be registered with the Commission for Social Care Inspection was ready to be submitted and the owner said he would ensure it would be posted the week of the inspection. There had been some hold up with the manager getting her Criminal Record Bureau check processed. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 25 She had previous experience of managing a care home and was approximately half way through the Registered Manager’s Award. She said she should have completed this by Christmas 2007. It was evident that since her appointment in November 2006, the manager had worked hard to address the problems identified at previous inspection visits. Due to the large number of areas needing to be improved, she had prioritised areas in relation to the health and safety of residents. Significant improvements were apparent in respect of how residents were being cared for, up to date risk assessments and comprehensive care plans were in place, more staff had been booked on training courses, staff supervision had commenced, resident and staff meetings were now taking place, equipment servicing was up to date, the maintenance programme was continuing, the recruitment policy was being adhered to and policies/procedures had been updated. Residents knew who the manager was and said they would go to her or the owner if there was a matter they needed addressing. Residents described the manager as “good”, “friendly”, “very nice indeed” and “spends time with us”. They also passed very positive comments about the owner and one resident said “he’s very good” and another said, “he looks after us very well”. Staff considered the manager to be open and approachable and felt she had already made changes within the home that benefited the residents and themselves. Due to having prioritised health and safety of residents, the manager had not yet had time to fully implement the quality assurance procedure. In order to measure the quality of the service being received by residents, the manager had recently sent out questionnaires to relatives, GP’s and District Nurses but no returns had been received. A more informal system of obtaining residents’ views was being undertaken by chatting to each person on an individual basis. However, the feedback given was not being recorded and this should be considered. A resident meeting had been held on 5 February 2007 and minutes of the meeting were seen. Some comments about the food had been made and the manager had addressed some requests, which had been made, such as occasional tripe teas and braised steak. Their other suggestions were being incorporated into the new menus, which were almost completed. The meeting had also highlighted that the residents wanted to have a hairdresser visit the home but not on a weekly basis. This had been organised and residents advised the manager when they wanted her to visit. Discussion took place about holding these meetings on a more regular basis and the manager said she would do so. She did however, say that due to the low number of residents currently living at the home, some of them were not interested in attending such meetings. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 26 All residents spoken with were happy with the arrangements regarding personal monies. The registered provider did not act as appointee for any residents. Where the home had involvement with residents’ monies, appropriate records and receipts were held. Three residents’ monies were checked, two of which were in order. The monies for one person were in excess of what they should have been so the manager said she would go through the finance record to see where the error had occurred. The manager had started a supervision system and was working systematically through the staff team. All but the more recently recruited staff were said to have received supervision and some supervision notes were seen on the files inspected. As she worked on the floor, she also observed staff practice and addressed shortfalls or good practice individually with the staff. Staff meetings were taking place, the most recent one being held on 14 June 2007. The minutes of the meeting were seen. A night staff meeting had also take place on 11 April 2007. Provision of health and safety training had improved. All but two of the most recently recruited staff had undertaken moving/handling training and the manager said these people would be booked on the next available course. Mandatory training was done on a rolling programme. It was however, difficult to determine exactly when and who had completed all the necessary training due to no training matrix being in place. This should be addressed and any gaps in training should then be rectified. During the inspection, it was identified that there was no fire risk assessment in place. The manager said she would contact the Greater Manchester Fire Service to seek advice. The returned Annual Quality Assurance Assessment form recorded that all maintenance checks were up to date. Random samples of the gas certificate, servicing of lift and hoists and fire equipment were undertaken and found to be in order. The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 23(2)(j) Requirement The hot water in several identified bedrooms and bathrooms was insufficiently warm so that residents could not have a satisfying wash or bath. (Previous timescale of 28/02/07 not met). Timescale for action 31/08/07 The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations The manager should consult with the residents in order to determine what activities and trips out they would like and record this within an activities programme, which should then be implemented. Activity sheets in care plan files should be completed by all staff, when any one to one or group activities have been done. The new menus should include the suggestions made by the residents at their last resident meeting. The manager should seek the advice of the GMC Fire Department in respect of writing a fire risk assessment for the home. Skills for care training should show how competencies have been assessed and be completed within the first 12 weeks of employment. A training matrix should be formulated so that the manager will know, at a glance, which staff still require mandatory and refresher training. 2 3 4 5 6 OP12 OP15 OP19 OP30 OP30 The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Rosemary Care Home DS0000066311.V343909.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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